Simsek Tayup, Dogan Askin, Simsek Mehmet, Pestereli Elif
Department of Obstetrics and Gynecology, Akdeniz University School of Medicine, Antalya, Turkey.
J Obstet Gynaecol Res. 2008 Aug;34(4 Pt 2):759-62. doi: 10.1111/j.1447-0756.2008.00921.x.
The incidence of heterotopic/ectopic pregnancy has risen in recent years, largely due to more frequent use of ovulatory medicine and increased incidence of pelvic inflammatory disease. In a natural cycle, it is a very rare event. Most heterotopic/ectopic pregnancies are localized in the uterine tube and, usually, it is diagnosed when symptoms develop. We report the case of a 37 year-old, gravida 2, para 0, abortion 1 woman with no known risk factors for heterotopic pregnancy. The patient attended the emergency department because of acute abdominal pain. She was evaluated in our department and a heterotopic twin pregnancy in the tube was diagnosed by transvaginal sonography. Intrauterine pregnancy with positive fetal cardiac activity at 9 weeks of gestation according to crown-rump length measurement was detected. Laparotomy was carried out because of acute abdominal syndrome. Right ruptured tubal ectopic/heterotopic pregnancy and hemoperitoneum were diagnosed. Right salpingectomy was carried out. Pathology revealed monochorionic twin tubal pregnancy. In a review of the literature, this is first case of twin tubal pregnancy in one uterine tube. In conclusion, heterotopic pregnancy in twin form in the uterine tube is possible in natural cycles. Intrauterine pregnancy does not exclude extrauterine pregnancy in natural cycles.
近年来，异位妊娠的发生率有所上升，主要原因是促排卵药物使用更为频繁以及盆腔炎发病率增加。在自然周期中，这是非常罕见的情况。大多数异位妊娠发生在输卵管，通常在出现症状时才被诊断出来。我们报告一例37岁、孕2产0、流产1次的女性病例，该患者无已知的异位妊娠危险因素。患者因急性腹痛前往急诊科就诊。她在我们科室接受了检查，经阴道超声检查诊断为输卵管双胎异位妊娠。根据头臀长度测量，在妊娠9周时检测到宫内妊娠且有胎心搏动。因急性腹部综合征进行了剖腹手术。诊断为右侧输卵管破裂异位妊娠并腹腔积血。实施了右侧输卵管切除术。病理显示单绒毛膜双胎输卵管妊娠。在文献回顾中，这是首例发生在一侧输卵管的双胎输卵管妊娠。总之，在自然周期中，输卵管内双胎形式的异位妊娠是可能的。自然周期中的宫内妊娠并不排除宫外妊娠。
